Hypospadias with Intact Prepuce: A Spectrum of Anomalies and their Reconstruction

Rajendran Ramaswamy; Samir Morsi Hegab; Hany Fawsy; Saif Saeed Ghalib; Mohamed Shawky; Ghazi Mukattash

doi:10.4103/jiaps.jiaps_172_23

Hypospadias with Intact Prepuce: A Spectrum of Anomalies and their Reconstruction

J Indian Assoc Pediatr Surg. 2024 Mar-Apr;29(2):129-136. doi: 10.4103/jiaps.jiaps_172_23. Epub 2024 Mar 4.

Authors

Rajendran Ramaswamy¹, Samir Morsi Hegab¹, Hany Fawsy¹, Saif Saeed Ghalib¹, Mohamed Shawky¹, Ghazi Mukattash¹

Affiliation

¹ Department of Pediatric Surgery, Maternity and Children's Hospital (Under Ministry of Health), Najran, Saudi Arabia.

Abstract

Aims: The aim of the study was to perform a detailed analysis of the clinical characteristics of megameatus with intact prepuce (MIP) and to audit our results of reconstructive surgeries on MIP.

Materials and methods: Design: Retrospective analysis. Setting: Pediatric surgery department of tertiary level. Subjects, methods: Hospital records and pictures of MIP operated over a 9-year period. Age, size of penis, circumcised or not, shape of glans, external urethral meatus (EUM), urethral plate (UP), chordee, distal urethra, reconstructive surgery, and complications were analyzed. Postoperative result was objectively assessed by Hypospadias Objective Scoring Evaluation (HOSE).

Results: Twelve of 254 hypospadias were MIP (incidence = 4.72%). The mean age at operation was 38.25 months (12-87 m). Patients sought circumcision or surgical correction of anomaly. Two patients were precircumcised. MIP was coronal 7, subcoronal 3, and glanular 2. Meatus was wide in 10 and normal in 2. Glans penis was wide in 9 and conical in 3. UP was wide (9), moderately wide (2), or narrow and shallow (1). In two cases of wide deep UP, distal septum was present. Distal urethra was nondilated in all but 1, which had megalourethra. Reconstructive surgery was Tubularized Urethral Plate Urethroplasty (7 cases) or classical Snodgrass (Tubularised incised plate urethroplasty (TIPU), with superimposed vascular dartos flap (5 cases). The megalourethra underwent partial excision and TIPU. Distal UP-septum was incised. Urethral injury (2 cases) and UP injury (1 case) were intraoperative complications. One postoperative complication (ventral glans necrosis) resulted. The mean follow-up period was 4.79 months (1-12 m). In the postoperative follow-up, 11 (92%) had HOSE score 14-16, whereas one had HOSE 13.

Conclusion: Some hypospadias cases which have intact prepuce have no megameatus; hence, they cannot be termed MIP. All cases of hypospadias having intact prepuce can be covered by the umbrella term "Hypospadias with Intact Prepuce (HIP);" MIP is a large subgroup under HIP. HIP presents with a spectrum of anomalies of glans, EUM, and UP. Repair by tubularization of UP without or with midline incision gives excellent results.

Keywords: Hypospadias with intact prepuce; megalourethra; megameatus; megameatus with intact prepuce; tabularized incised plate urethroplasty; tabularized urethral plate urethroplasty.